APTIVUS 250MG CAPSULE (120 BOTPL) (NDC: 00597000302)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,074.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,074.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,079.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,079.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,077.06 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,077.06 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,073.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,073.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,074.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$12.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,074.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,078.61 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,078.61 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,078.61 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,078.61 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,078.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,078.61 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,078.61 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,078.61 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,084.58 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,084.58 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,084.58 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,084.58 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,084.58 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,084.58 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,084.58 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,084.58 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,079.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,079.41 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,079.41 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,079.41 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,079.41 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,079.41 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,079.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,079.41 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,079.41 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,079.41 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,079.41 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $1,079.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,079.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,079.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-095 (PFFS)
|
$16.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,077.06 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,077.06 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
Health Plan SecureCare (HMO)
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
20% | n/a | None | $1,063.58 |
Browse Plan Formulary |
SecureChoice (PPO)
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
20% | n/a | None | $1,063.58 |
Browse Plan Formulary |
Humana Gold Choice H2944-096 (PFFS)
|
$20.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-096 (PFFS)
|
$20.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-082 (PFFS)
|
$21.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-082 (PFFS)
|
$21.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $1,135.09 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,084.38 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,077.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,077.57 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,077.57 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,077.57 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,077.57 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,077.57 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,077.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,077.57 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,077.57 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,065.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,065.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,065.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,065.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,065.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,065.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,065.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,065.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,077.57 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,077.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,077.57 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,077.57 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,077.57 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,077.57 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,077.57 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,077.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,077.57 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,065.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,065.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,065.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,065.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,065.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,065.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,065.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,065.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,092.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,092.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,092.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,092.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,092.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,092.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,092.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,092.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,092.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,092.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,092.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,092.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,092.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,092.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,092.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,092.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,092.83 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,092.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-080 (PFFS)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-081 (PFFS)
|
$25.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,052.41 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-094 (PFFS)
|
$26.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,064.90 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
FreedomBlue PPO Standard (PPO)
|
$33.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life HMO Rx Enhanced West Virgini
|
$34.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $908.42 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced West Virgini
|
$34.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $908.42 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced West Virgini
|
$34.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $908.42 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced West Virgini
|
$34.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $908.42 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced West Virgini
|
$34.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $908.42 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced West Virgini
|
$34.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $908.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life HMO Rx Enhanced West Virgini
|
$34.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $908.42 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$34.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,112.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,078.61 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,078.61 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,078.61 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,078.61 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,078.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,078.61 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,078.61 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,078.61 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,084.58 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,084.58 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,084.58 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,084.58 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,084.58 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,084.58 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,084.58 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,084.58 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,079.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,079.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,079.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,079.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,079.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,079.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,079.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,079.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,079.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,079.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,079.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $1,079.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,112.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,117.88 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,115.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,112.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,117.88 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,115.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,112.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,117.88 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,115.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,112.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,117.88 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,115.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,112.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,117.88 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,115.81 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,112.93 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,117.88 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,115.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,112.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,117.88 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,115.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,112.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,117.88 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,115.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,112.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,117.88 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,115.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,112.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,117.88 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,115.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,112.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,117.88 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,115.81 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,112.93 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,117.88 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $1,115.81 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced West Virgini
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $908.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life PPO Rx Enhanced West Virgini
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $908.42 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced West Virgini
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $908.42 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced West Virgini
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $908.42 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced West Virgini
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $908.42 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced West Virgini
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $908.42 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced West Virgini
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $908.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PPO Deluxe (PPO)
|
$58.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $1,070.53 |
Browse Plan Formulary |